Owners of Saddleback Memorial Medical Center are looking to replace it as a three-story state-of-the-art ambulatory care center, which would close the emergency room and may strain nearby ERs. NICK AGRO , NICK AGRO, STAFF PHOTOGRAPHER

Next steps

A feasiblity study will consider how to transition from an acute-care hospital into a state-of-the-art ambulatory health care campus

If the Saddleback board approves the plan in the spring, the project could take 22 months, with estimated tenancy sometime around March 2017

For now, and until a final decision is made, Saddleback San Clemente continues as an acute-care hospital

Once a "go" is given and transition begins, an advanced urgent care center would operate, using the current emergency room space, with imaging services provided by San Clemente Imaging Center

Source: MemorialCare

The owners of San Clemente’s 42-year-old hospital are looking to remake it from the ground up, transforming the space into an outpatient health center they see as the future of medicine.

MemorialCare Health System is launching a feasibility study for transitioning the 73-bed hospital at 654 Camino de los Mares into a three-story, 103,000-square-foot ambulatory care center designed to offer a wide range of services with more convenience and lower cost than an acute care hospital can provide.

Steve Geidt, CEO for Saddleback Memorial Medical Center in Laguna Hills and Saddleback Memorial’s San Clemente campus, said the change is in response to a changing market, as consumers steer away from traditional hospitals and toward outpatient care.

On average, only 19 of Saddeback San Clemente’s 73 licensed beds are occupied, and it isn’t a trend only affecting Orange County or San Clemente, Geidt said. A year-long study of the future of the San Clemente facility led to a go-ahead from the board to pursue a new vision.

“We think it is actually going to be a model,” Geidt said. “We think it is something the community will be very proud of.”

The proposal could cost MemorialCare $40 million, Geidt said, but there would be another cost. Saddleback San Clemente no longer would operate an emergency room.

“It would be a shame for the citizens of San Clemente and Dana Point to lose their ER,” said Capt. Steve Concialdi, Orange County Fire Authority spokesman. “It’s quite an ETA to get from San Clemente to Mission (Hospital), especially during heavy traffic. We want to get the patient to the closest hospital in the shortest amount of time.”

Bill Lockhart, OCFA battalion chief for emergency medical services, said the agency delivers eight to nine patients a day to San Clemente’s emergency room from San Clemente, Dana Point, San Juan Capistrano or Camp Pendleton, and the fire authority isn’t allowed to take emergency patients to an urgent care facility, even an advanced one like MemorialCare is proposing. He said closure of San Clemente’s emergency room means a longer drive and would impact Mission’s emergency room, which at times is saturated and cannot accept patients.

That could mean driving to the next hospital, Lockhart said. It could also mean “wall time.”

“Wall time is when we arrive at the hospital and we can’t place a patient in a hospital bed, and we have to place the patient on a gurney,” he said. “It can be a couple of hours of wall time. The bottom line is, we are unavailable for another call.”

As South County grows, closure of an emergency room could have a ripple effect on other emergency rooms, OCFA officials said.

“I can envision the time in the not-too-distant future when the closest available hospital (from San Clemente) will be Saddleback Laguna Hills or Hoag Irvine,” Lockhart said. “To our coverage, that will be significant.”

Geidt said larger hospitals designated as cardiac-receiving and stroke-receiving ERs and as trauma centers receive critical patients not currently sent to San Clemente, even if it is the closest emergency room. He pledged to work with Orange County’s Emergency Medical Services “to ensure that there isn’t a gap in coverage.”

OCFA officials said full-arrest cardiac patients do go to the San Clemente emergency room when it is closest, as do drowning victims and other cases where the priority is to reach the nearest emergency room and stabilize the patient.

Tony Struthers, administrator at Saddleback San Clemente, said market realities may force a change.

“In order to have an ER, you have to have an acute-care hospital attached,” he said. “Acute-care hospitals may not be the best way to completely serve the community.”

Market forces, health plans and physician groups are pushing business out of hospitals to outpatient centers and freestanding centers, he said.

“It’s making it harder and harder for us to maintain that business model of an acute-care hospital, and especially a small acute-care hospital,” he said. “We don’t have as much to fall back on as the larger hospitals.”

Geidt said Saddleback is meeting with community stakeholders to share the vision and collect input.

“It’s a conversation that is best done in person,” he said. “It’s a complex proposal. We’re talking about building something from the ground up that is not a hospital – we’re talking about a complete ambulatory center, ambulatory surgery center, 24-hour urgent care ideally… we may even have beds in some of these service lines.”

Virginia Pillsbury, former chair of the hospital’s support guild, sees a tough scenario.

“They can’t keep the hospital open if they can’t pay for it,” she said. “They’ve put tons of money into the hospital and good staff. They bought a lot of high-tech equipment. They have done all the right things. I think it’s a great hospital, and if it works out, it will be a great asset to the community.”

Don Hansen, who retired at age 80 from the Saddleback board, served on San Clemente hospital boards for 27 years under a succession of owners. He sees a need for change. On a recent visit, he found 13 patients in the hospital.

“If that hospital hadn’t been at the bottom of the hill, I’d be dead,” he said. “My heart quit and they put in a pacemaker. I made a promise that as long as I’m around here I’d try to keep that hospital open. I’m changing. I’m listening to what they are saying.”

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